Performance Plus Through Baldrige

1. Performance Plus through Baldrige

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a. PIR uses the criteria for performance excellence, a “world-class” diagnostic tool, to help leaders focus their organization’s improvement efforts to:

1. Accelerate the alignment of the organization around your strategic objectives, vision, strategic challenges and customer requirements.

2. Move your organization beyond the reactive mode.

2. Performance Plus through Analytics

A. Strategic Pricing Services

1. Increase net revenue - Historically at least one half of a percent of gross revenues

2. Improve your organization’s transparency

This analysis establishes defensible and transparent pricing strategies for areas where pricing changes may be warranted based upon a hospital’s stated business parameters. We utilize a proprietary technique of “Computational Concurrency”® to mathematically model (C2M2®) the business policies, financial rules, and market objectives defined by a Hospital in order to perform an analytical assessment of all hospital-based CPT/HCPCS services. As a secondary benefit, C2M2® mathematically ensures the optimization of the net revenue resultant from such pricing changes. The defined business parameters loaded into the automated model compare current Hospital prices to competitive and peer market based pricing, cost based derivatives, and comparative reimbursement benchmark data, in conjunction with applying the reimbursement terms of the Hospital’s payer contracts. All modeled business rules are concurrently applied to identify analytically precise price structures for appropriate alignment of a hospital’s price position per the directives of its business policies and practices

B. Charge Capture Services

1. Increase net revenue - Historically three to five percent

2. Steamline processes

This service increases billing accuracy through utilization of charge capture analysis and coding review. An analytical assessment is performed on the charge capture processes, coding, and billing practices; an empirical analysis is undertaken of the input (clinical services) and outputs of the process (healthcare claims) of the revenue cycle operation. This effort is focused on comparing a procedural based inventory of Hospital services with a national repository of stated industry standards to identify the ultimately billed services to associated candidate process changes, thereby enabling an estimation of the magnitude of opportunity that could result from earmarked candidate process changes. The second phase of the review focuses on the completeness and accuracy of hospital claims. Clinical documentation and claims are often a component of this analysis. The final component of this service is work performed onsite with Hospital staff to develop, deliver, and assist in the implementation of any appropriate process change.

C. Disproportionate Share Services

This service increases revenue reimbursement by increasing the accuracy of the Client’s Medicare Disproportionate Share (DSH) payments due for past or current fiscal years of a Hospital. We focus on increasing the accuracy of the hospital’s eligible DSH payments for all applicable prior and current cost reporting years. This evaluation is performed by a comprehensive evaluation of inpatient stays to determine the Medicaid eligibility status for each patient during their stay. The outcome from this service will be the determination with complete documentation and support for the exact and/or additional patient days eligible for reimbursement by the federal Medicare DSH program for submission to the hospital’s fiscal intermediary.

3. Where is your organization on its performance improvement journey?


b. If your organization is currently in section 1 or 2 you can benefit from our services